Bowel cancer screening campaign

Campaign overview

Cancer Research UK will be delivering an advertising campaign aimed at raising awareness of the NHS Bowel Cancer Screening Programme and encouraging those eligible (60 – 74 year olds) to participate, from August 2015 to March 2016. Direct mail is also planned to run alongside advertising, from January to March 16, in a selection of target areas. The contents of the direct mail, and target areas to receive it, are to be confirmed in September.

The advertising will include posters in bus shelters; posters on telephone kiosks; posters inside and on the outside of buses; adverts on pharmacy bags and regional press articles and will run in the following seven regional areas:

  1. Lancashire (Blackpool and West Lancashire CCGs)
  2. Merseyside (Knowsley, Liverpool, South Sefton, Halton and St Helens CCGs)
  3. Greater Manchester (all 12 CCGs)
  4. Yorkshire (Bradford City, Bradford Districts & Hull CCGs)
  5. North East (Newcastle West, Newcastle North and East and South Tees CCGs)
  6. Leicester (Leicester City CCG)
  7. South (Oxfordshire, South Reading & Slough CCGs)

The campaign will be live across all seven regional areas on the following dates between August 15 and March 16:

Phase one:

  • Burst one: 24th August to 27th September
  • Burst two: 5th October to 8th November

Phase two:

  • Burst three: 18th January to 21st February
  • Burst four: 7th March to 3rd April
As part of Cancer Research UK's efforts to beat bowel cancer sooner, an initial pilot project aimed at facilitating participation in the NHS Faecal Occult Blood Test (FOBT) (bowel cancer screening) was implemented in Greater London (2014). Four interventions were piloted including:

A. CRUK endorsement flyer1B. CRUK flyer + kit enhancement pack2C. CRUK flyer + advertising; and D. CRUK flyer + kit enhancement pack + advertising. The most intensive intervention (D) achieved a maximum increase in uptake of 6.0% among 60 year olds who had been invited for screening for the first time3.

A second pilot ran across Wales from February to early April 2015, which explored the impact of mailing the CRUK endorsement flyer as a separate, personalised direct mailing (i.e. a letter, not A5 flyer), along with a cheaper version of the kit enhancement pack (i.e. gloves only). The impact of advertising, independent of any other direct mail interventions was also tested. Initial results are expected late-August 2015.

1CRUK A5 endorsement flyer was inserted in with the NHS test kit. It outlined benefits & risks of screening and provided an endorsement from CRUK

2CRUK kit enhancement pack containing a poo catcher and pair of latex free gloves was mailed as separate direct mail +2 days following an NHS test kit

3Cancer Research UK. Bowel Cancer screening: Greater London pilot Campaign Summary. March 2015. London. Cancer Research UK

The direct mail activity will be confirmed following analysis of initial uptake data results from the Wales pilot (due Sept 15). Insights from that pilot will inform the contents of the mailing, which regional areas will be suitable to receive the mailing, and which groups within the eligible population should be targeted.

The screening hubs or their contracted mailing house will manage the direct mail activity. CRUK will not have access to patient data; we will supply the direct mail materials only. Depending on the outcome of the Wales pilot, the direct mail will contain one of the following:

A. CRUK A4 letter outlining the benefits (and risks) of participating in the NHS bowel cancer screening programme and a clear endorsement from CRUK recommending people take part.

B. CRUK A4 letter + x1 kit enhancement pack containing x3 pairs of latex free gloves.

C. CRUK A4 letter + x3 kit enhancement packs containing latex free gloves and a poo catcher.

  • Advertising: Evidence indicates that poor knowledge of the benefits and eligibility of the NHS Bowel Cancer Screening programme1and being asymptomatic4, are contributing factors to poor uptake, resulting in people making an uninformed choice not to participate. Evidence suggests that during the London pilot, the kit enhancement pack and endorsement letter achieved a greater impact when supported with advertising. In North East London, a pre and post on-street survey found those who recognised the campaign posters were more likely to understand the purpose of bowel screening, have higher intentions to complete the test and believe it would be less disgusting and easy to complete5.
  • Kit enhancement packs: ‘Unpleasantness’ is a significant barrier for many considering completing an FOBT kit2 6 7. With this in mind, kit enhancement packs were developed to help people collect their stool sample.

We regularly review the growing evidence base of research, campaigns and localised interventions aimed at increasing uptake of bowel cancer screening, along with closely monitoring broader early diagnosis work aimed at improving the early detection of bowel cancer. This activity forms part of a wider strategy aimed at improving outcomes for bowel cancer patients. Other research and resources are in development by CRUK.

Email Rachael Ogley, Early Diagnosis Manager (Translation), for further information about other resources and insight available. 

3Hewitson et al. (2011). Primary care endorsement letter and a patient leaflet to improve participation in colorectal cancer screening: results of a factorial randomised trial. BJC:105:475-480

Ekberg M, Callender M, Hamer H & Rogers S (2014). Exploring the decision to participate in the National Health Service Bowel Cancer Screening Programme. Eur J Cancer Prevention 2014 Sep;23(5):391-7.

5Annual Report Bowel Cancer Screening Programme, London Programme Hub, April 2011 – March 2012  

Siu Hing Lo, J Waller, J Wardle and C von Wagner (2013). Comparing barriers to colorectal cancer screening with barriers to breast and cervical screening: a population-based survey of screening-age women in Great Britain. Journal of Medical Screening;20:73–79

C K Palmer, M C Thomas, C von Wagner and R Raine (2014). Reasons for non-uptake and subsequent participation in the NHS Bowel Cancer Screening Programme: a qualitative study. British Journal of Cancer; 110: 1705–1711 

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